Manager, Coding, Compliance, Auditing and Education

DEBORAH LINEHAN RHIT, PCS, CPC-I, CPC

OCCUPATION NOVEMBER 2000----PRESENT, DENVER HEALTH AND HOSPITAL AUTHORITY – THE REGION’S ACADEMIC LEVEL I TRAUMA CENTER AS PART OF THE GME PROGRAM AT THE UNIVERSITY OF COLORADO,

MEMBER OF THE UNIVERSITY HEALTH CONSORTIUM

MANAGER OF CODING AND COMPLIANCE

• CONCURRENT AND RETROSPECTIVE AUDIT OF CODED AND BILLED PROFESSIONAL SERVICES FOR COMPLIANCE AND OPTIMAL REIMBURSEMENT CRITERIA. PROVIDE SUMMARY REPORTS AND DEVELOP EDUCATIONAL PRESENTATIONS AND MATERIALS FOR CODERS, BILLERS, COMPLIANCE STAFF AND PROVIDERS (RESIDENTS, ATTENDING PHYSICIANS AND NPP’S). SCHEDULE AND PRESENT EDUCATIONAL SESSIONS AS REQUIRED.

• RECRUIT, HIRE, TRAIN, SUPERVISE, EVALUATE , COACH AND RETAIN QUALITY CODING, BILLING, COMPLIANCE AND AUDITING STAFF TO MAXIMIZE ETHICAL AND COMPLIANT CODING AND CHARGE CAPTURE OF THE SERVICES PROVIDED AT DENVER HEALTH.

• DEVELOP AND INITIATE ICD-10 EDUCATIONAL PROGRAM FOR PRO-FEE CODING AND BILLING STAFF TO PREPARE FOR OCTOBER 2014 IMPLEMENTATION AND CHANGE-OVER. PREPARE DOCUMENTATION IMPROVEMENT PROGRAM WITH TIMELINE AT LEAST 12 MONTHS PRIOR TO 10/14 FOR OPTIMAL DOCUMENTATION AND PROVIDER PERFORMANCE OPPORTUNITY.

• WORK WITH OTHER MANAGERS AND DIRECTORS TO CONTINUALLY UPDATE AND MAINTAIN PHYSICIAN AND CLINIC STAFF EDUCATION TO SUPPORT FULL COMPLIANCE, AS APPLICABLE, OF: CPT CODES, ICD-9-CM CODES, CMS RULES, COMPLIANT DOCUMENTATION, AND CHARGE CAPTURE PROCESS.

• DEVELOP, UPDATE AND MAINTAIN AND TEACHING PHYSICIAN ORIENTATION TRAINING PROGRAM FOR ALL NEW PROVIDERS TO INSURE ACCURATE INFORMATION IS DISSEMINATED PRIOR TO PATIENTS BEING SEEN REGARDING DOCUMENTATION GUIDELINES.

• DEVELOPS AND MAINTAIN QUARTERLY ON-LINE SUPPLEMENTAL MATERIALS FOR PROVIDERS, CODERS, BILLERS AND COMPLIANCE STAFF TO REFER TO FOR UPDATES. THIS MATERIAL WILL BE USED FOR ANNUAL COMPETENCY MODULES.

• CREATE, UPDATE AND MAINTAIN ANNUAL COMPETENCY MODULES TO BE USED FOR ALL PROVIDERS, CODING, BILLING AND COMPLIANCE STAFF ANNUAL PERFORMANCE REVIEWS TO ENSURE BASIC UNDERSTANDING OF MOST CRITICAL AREAS OF CONCERN FOR THE ORGANIZATION.

• DEVELOP REGULAR AUDIT SCHEDULE OF CODERS TO MONITOR QUALITY AND COMPLIANCE TO MEET AUTHORITY COMPLIANCE PLAN.

• DEVELOP REGULAR AUDIT SCHEDULE OF ALL BILLABLE PROVIDERS TO MONITOR QUALITY AND COMPLIANCE TO MEET AUTHORITY COMPLIANCE PLAN.

• ESTABLISHES, IMPLEMENTS AND UPDATES POLICIES AND PROCEDURES TO INSURE STANDARDS OF ETHICAL CODING AND CORPORATE COMPLIANCE PLAN ARE UNDERSTOOD AND FOLLOWED AT ALL TIMES, AS NEEDED.

• MONITORS AND MANAGE WORKFLOW BETWEEN PROVIDERS AND CODING STAFF AND BETWEEN CODING STAFF AND BILLING TO INSURE STEADY REVENUE STREAM. KEEP MANAGEMENT INFORMED OF ANY BACKLOG IN TIMELY MANNER.

• PERFORM REGULAR CODING REVIEWS/”SHADOW” ROUNDS WITH PHYSICIANS FOR THE PURPOSE OF PROCESS OR DOCUMENTATION IMPROVEMENT, AS NEEDED.

• WORKS WITH PHYSICIAN BILLING ON REIMBURSEMENT ISSUES TO INSURE APPROPRIATE PAYMENTS ARE RECEIVED.

• CONDUCT EDUCATIONAL MEETINGS WITH BILLING STAFF/CODING STAFF/COMPLIANCE STAFF, WHEN TIME ALLOWS, ENHANCING THEIR UNDERSTANDING OF ISSUES THAT IMPACT REIMBURSEMENT. (CE OPPORTUNITIES)

• PARTICIPATE IN MEETINGS AND COMMITTEES TO REDUCE WASTE, INCREASE VALUE AND APPLY “LEAN” PRINCIPLES TO OUR WORK ENVIRONMENT.

• EARN BLACK BELT THROUGH DH TRAINING USING THE TOYOTA “LEAN” TRAINING TOOLS AND STRIVE TO MEET MONTHLY GOAL SET BY EXECUTIVE STAFF OF NEW REVENUE OR SAVINGS.

• SERVE AS RESOURCE FOR PROVIDERS, CODERS, BILLERS AND COMPLIANCE STAFF FOR DOCUMENTATION, CODING, BILLING OR REGULATORY ISSUES FROM FEDERAL, STATE OR PAYERS AND PROVIDE SUPPORTING INFORMATION WITH RESPONSE.

• SEND OUT QUARTERLY NEWSLETTER WITH COMPLIANCE, CODING AND/OR BILLING UPDATES “IN THE NEWS”.

JUNE 2006 –JUNE 2011 - DENVER HEALTH CAREER DEVELOPMENT PROGRAM

INSTRUCTOR –

• MEDICAL TERMINOLOGY/INTRO TO ANATOMY & PHYSIOLOGY

• BASIC ANATOMY AND PHYSIOLOGY/PATHOPHYSIOLOGY

• PMCC – PROFESSIONAL MEDICAL CODING CURRICULUM

SEPTEMBER 2002 – MAY 2006 - DENVER PUBLIC SCHOOLS/EGOS

INSTRUCTOR –

• MEDICAL TERMINOLOGY/INTRO TO ANATOMY & PHYSIOLOGY

• BASIC ANATOMY AND PHYSIOLOGY/PATHOPHYSIOLOGY

• PMCC – PROFESSIONAL MEDICAL CODING CURRICULUM

• BILLING AND CODING CERTIFICATE PROGRAM

NOVEMBER 1995 – NOVEMBER 2000 – CABOT MARSH CORP/QUADRAMED CORP. , ALLENTOWN, PA

SR. CONSULTANT – PHYSICIAN /BUSINESS SERVICES DIVISION

• PERFORMED PATH AUDITS AND CIA REVIEWS AS CONTRACTOR/SUB-CONTRACTOR OF OIG (OFFICE OF THE INSPECTOR GENERAL)- DEPARTMENT OF JUSTICE

• DEVELOPED AND PRESENTED EDUCATIONAL MATERIAL FOR PROVIDERS/GROUPS/INSTITUTIONS REGARDING MEDICAL SERVICE DOCUMENTATION, CODING, BILLING, REIMBURSEMENT OR COMPLIANCE.

• PROJECT MANAGER FOR CODING AND COMPLIANCE AUDITS

• PROJECT MANAGER FOR BACKLOG CODING SERVICES

• ASSIST LEGAL STAFF WITH DEVELOPMENT AND PRESENTATION OF COMPLIANCE AND REGULATORY PROGRAMS AS APPLICABLE TO PROVIDER SERVICES

• APC EDUCATION FOR AMBULATORY SURGERY CENTERS

NOVEMBER 1992- NOVEMBER 1995 – OB/GYN ASSOCIATES, AURORA, CO.

CODER/ BILLER / REVENUE CYCLE ANALYST

1982-1992 – CAPITOL FEDERAL SAVINGS AND LOAN ASSOCIATION, DENVER, CO.

VP., COMMERCIAL/CONSUMER LOAN OFFICER

1975-1982 – THIRD NATIONAL BANK OF NASHVILLE, TN

RESIDENTIAL/ CONSUMER OFFICER AND LEASING ASSISTANT VP

EDUCATION

SEPT 1993- MAY 1995 ARAPAHOE COMMUNITY COLLEGE

• AAS – ASSOCIATES DEGREE OF APPLIED SCIENCE /HIM PROGRAM

CERTIFICATIONS

• EARNED RHIT CERTIFICATION OCTOBER 1995

• EARNED CPC CERTIFICATION 1997

• EARNED CCP-P CERTIFICATION 2004

• EARNED CPC-I CERTIFICATION 2001

• EARNED PCS CERTIFICATION 2010

ORGANIZATIONAL AFFILIATIONS

AHIMA – AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION

ACMCS – AMERICAN COLLEGE OF MEDICAL CODING SPECIALISTS

AAPC – AMERICAN ACADEMY OF PROFESSIONAL CODERS

HCCA - HEALTHCARE COMPLIANCE ASSOCIATION

NOTABLES:

CONTRIBUTING AUTHOR TO AHIMA PUBLICATIONS: “PROCEDURAL CODING AND REIMBURSEMENT FOR PHYSICIAN SERVICES” BY LYNN KUEHN

KEYNOTE SPEAKER AT THE 2011 AHIMA COMPUTER-ASSISTED-CODING SUMMIT IN BALTIMORE, MD

FEATURED IN JOURNAL OF AHIMA – SPECIAL EDITION AUGUST 2011 PROFESSIONAL DEVELOPMENT : “CLEAR ROAD AHEAD” BY CHRIS DIMICK (SEE ATTACHMENTS)

FEATURED IN FOR THE RECORD - OCTOBER 2011 “CODING’S NEW WORLD” BY ELIZABETH S. ROOP (SEE ATTACHMENTS)

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